Endometriosis is a condition that affects around 11% of American women of reproductive age. The condition is associated with menstrual cramps and pain predominantly located in the abdomen. Patients may also experience pain during intercourse, when moving their bowels or during urination. Other symptoms can include bleeding or spotting between menstruation, digestive issues such as bloating, constipation and fatigue. In some cases, endometriosis can lead to fertility problems.
The condition is caused when the tissue that lines the uterus – the endometrium – grows outside of the uterus and into other areas of the body. This can affect the ovaries, fallopian tubes, the bladder, bowel, and rectum. It’s rare for endometriosis to spread to the lungs or brain.
Pain occurs because the tissue outgrowths may swell and begin to bleed which can lead to blockages in affected areas of the body, inflammation and the formation of scar tissue.
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The causes of endometriosis
The scientific community is not entirely sure what causes the condition, but there are a couple of factors that increase the likelihood of endometriosis. These include:
- Issues with blood flow during menstruation. When tissues shed during menstruation flow backward into other areas of the body, it may cause endometriosis.
- Hormones. The hormones estrogen and progesterone regulate endometrial tissue growth. Estrogen promotes cell growth whilst progesterone inhibits it. An imbalance in these hormones is suggested to contribute to the condition.
- Immune system responses. A weak immune system may also have an effect on how the body deals with destroying endometrial tissues outside of the uterus.
- Genes. There’s evidence that endometriosis may be inherited.
- Surgical procedures. In some cases, procedures such as a Cesarean or hysterectomy may cause endometriosis.
Endometriosis is not preventable, but there are a couple of lifestyle changes you can make to minimize your risk. Regular exercise and low body weight, reduced alcohol and caffeine consumption have been shown to reduce the levels of circulating estrogen in the female body, lowering the risk of endometriosis.
The birth control pill as a treatment option for endometriosis
Hormonal birth control pills may be a good option to manage the symptoms of endometriosis if you’re not looking to get pregnant any time soon. Studies have shown that women who take birth control pills have a reduced risk of the condition because they reduce menstrual blood flow by suppressing ovulation. This may slow down the growth of endometrial tissues.
There are various types of birth control pills, but most women are prescribed the estrogen/progesterone pill that comes in a 21-day pack. However, recent research cautions that combined oral contraceptives may merely provide temporary relief from endometriosis whilst progesterone-only treatments reduce endometrial tissue growth and pain long-term.
The progesterone-only pill (also called mini-pill) helps to regulate the menstrual cycle and reduces the pain experienced during periods.
Who can take the birth control pill?
The birth control pill for the treatment of endometriosis is not suitable for all women. Your healthcare provider will be able to determine if you qualify by reviewing your medical history. Generally, it is advised that women who are older than 35 years, those who smoke or those with medical conditions known to interfere with the contraceptive pill not be prescribed the medication.
What treatments for endometriosis are available if I’m trying to get pregnant?
Women who are looking to get pregnant may not want to take the contraceptive pill. Instead, your doctor may prescribe a medication that includes a gonadotropin-releasing hormone agonist which inhibits the hormones involved in endometriosis.
Surgery may be an option if your symptoms are severe and other treatment options have failed. Alternative treatments such as chiropractic methods, acupuncture, and herbal treatments or supplements have been successful for some women.
- Endometriosis | Womenshealth.gov. (2019). womenshealth.gov. Retrieved October 17, 2019, from <https://www.womenshealth.gov/a-z-topics/endometriosis#targetText=Endometriosis,women%20between%2015%20and%2044.&targetT>
- Parasar, P., Ozcan, P., & Terry, K. L. (2017). Endometriosis: Epidemiology, Diagnosis and Clinical Management. Current obstetrics and gynecology reports, 6(1), 34–41. https://doi.org/10.1007/s13669-017-0187-1
- Parente Barbosa, C., Bentes De Souza, A., Bianco, B., & Christofolini, D. (2011). The effect of hormones on endometriosis development. Minerva Ginecol., 63(4):375-86.
- Hansen, K. A., & Eyster, K. M. (2010). Genetics and genomics of endometriosis. Clinical obstetrics and gynecology, 53(2), 403–412. https://doi.org/10.1097/GRF.0b013e3181db7ca1
- Vercellini, P., Eskenazi, B., Consonni, D., Somigliana, E., Parazzini, F., Abbiati, A., & Fedele, L. (2010). Oral contraceptives and risk of endometriosis: a systematic review and meta-analysis. Human Reproduction Update, 17/2: 159-170. https://doi.org/10.1093/humupd/dmq042
- Casper, R. (2017). Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills. Fertility and Sterility, 107/3: 533-536. https://doi.org/10.1016/j.fertnstert.2017.01.003